对于未破裂的大脑动脉静脉形形的保守管理或干预后的结果
Rustam Al-Shahi Salman1, Philip M White2, Carl E Counsell3
1Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland.
JAMA
|April 24, 2014
概括
对于未破裂的大脑动脉静脉形形 (bAVMs) 的保守管理显示出比干预更好的长期临床结果. 这表明,对于患有bAVM的患者来说,可能更喜欢一种不那么侵入性的方法.
科学领域:
- 神经学 神经学
- 神经外科 神经外科
- 血管医学 血管医学
背景情况:
- 未破裂的大脑动脉静脉形形 (bAVMs) 构成出血风险,但由于有限的长期比较数据,最佳管理仍在争论中.
- 保守的治疗与干预性治疗 (栓塞,手术,放射性手术) 在长期结果方面尚未得到明确的比较.
研究的目的:
- 为了比较保守管理与干预治疗对未破裂的bAVMs的长期临床结果.
主要方法:
- 一项以人口为基础的初始队列研究跟踪了204名苏格兰居民 (≥16岁) 被诊断为12年未破裂的bAVM.
- 使用考克斯回归来比较结果,分析死亡或持续发病率 (初级) 和中风或bAVM相关死亡 (二级).
主要成果:
- 保守的管理与12年的二次结局 (中风或bAVM相关死亡) 的较低率有关 (aHR 0.37;95% CI,0.19-0.72).
- 虽然保守的管理在最初4年显示出对主要结果 (aHR0.59;95%CI,0.35-0.99) 的更好结果的趋势,但此后的比率变得相似.
- 接受干预的患者年轻,患大bAVM的可能性较小.
结论:
- 在16岁及以上的患者中,保守的管理似乎与未破裂的bAVM在12年内获得更好的临床结果有关.
- 需要进一步的长期跟踪,以确认这些观察到的关联的持续性.
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